Cigarette Smoking among Reproductive-Aged Women -- Idaho and New York

Smoking by mothers during pregnancy is associated with a range of serious adverse pregnancy outcomes. To identify strategies to reduce the prevalence of maternal smoking during pregnancy, state health departments should have current and specific information about smoking practices of these reproductive-aged women. This report presents findings from surveys conducted in Idaho and New York to determine family planning needs of reproductive-aged women; the surveys also gathered information on cigarette smoking practices of these women. The sampling methods and questionnaire were similar in both states (1,2).

During 1985, the Idaho Department of Health and Welfare conducted the first statewide Female Health Needs Assessment Telephone Survey. Clusters of residential telephone numbers were sampled to identify women aged 18-44 years; 2025 women were administered a standardized questionnaire regarding their smoking practices, their use of family planning methods, and other reproductive health topics (1). The New York Reproductive Health Survey was conducted during late 1988 and early 1989. Computer-assisted telephone interviews were used to collect data from 1910 women aged 15-44 years living in New York, excluding New York City (2). For this report, analysis of the New York data was restricted to 1809 women aged 18-44 years. In both surveys, current cigarette smoking was defined as responding "yes" to the question "Do you smoke cigarettes now?"

In Idaho and New York, 25.0% (95% confidence interval (CI)=22.8-27.1) and 31.6% (95% CI=29.0-34.1) of respondents, respectively, reported that they currently smoked cigarettes. Prevalence of current smoking did not vary substantially in either state by age group. In both states, however, unmarried women were more likely than married* women to be current smokers; 32.3% (95% CI=26.8-37.7) and 36.7% (95% CI=31.6-41.8) of unmarried women in Idaho and New York, respectively, were current smokers, compared with 23.1% (95% CI=20.9-25.4) and 28.7% (95% CI=25.8-31.7) of married women in Idaho and New York, respectively. Smoking prevalence also varied inversely with level of education in both states; in Idaho and New York, 55.2% (95% CI=47.4-63.0) and 43.1% (95% CI=38.8-47.5), respectively, of respondents with less than 12 years of education were current smokers, compared with 16.0% (95% CI=13.5-18.4) and 18.6% (95% CI=12.1-25.0) of respondents with greater than 12 years of education in Idaho and New York, respectively.

In Idaho, where information was collected about religious affiliation, 11.4% of Mormons were current smokers, compared with 28.2% of Protestants, 31.9% of Roman Catholics, and 42.9% of women who reported no religious affiliation. In New York, women who reported an annual income less than $25,000 were more likely to smoke (40.4% (95% CI=34.4-46.4)) than those who reported an income greater than or equal to $35,000 per year (26.3% (95% CI=22.8-29.9)). Among women who were current smokers, 20.0% (95% CI=16.4-23.8) in Idaho and 14.2% (95% CI=10.6-17.7) in New York reported smoking more than one pack of cigarettes per day.

In both states, women who reported having had a liveborn child were asked about their smoking practices during their most recent pregnancy. In Idaho and New York, 19.9% and 26.1% of women, respectively, smoked during their most recent pregnancy (Table 1). In both states, women with less than a high school education were more likely to smoke during pregnancy, as were unmarried women. In Idaho, Mormon women were least likely to smoke during pregnancy (9.7%). In New York, white women and women with an annual income less than $25,000 were more likely to smoke during pregnancy. In Idaho and New York, nearly equal percentages of women smoked more than one pack of cigarettes per day during pregnancy (12.1% (95% CI=8.0-16.3) and 11.6% (95% CI=7.1-16.0), respectively).

In Idaho, 27.7% (95% CI=22.1-33.2) of women taking oral contraceptives were current smokers; of oral contraceptive users aged 30-44 years, 30.4% (95% CI=18.1-42.6) smoked. In New York, 33.3% (95% CI=27.0-39.6) of women taking oral contraceptives also smoked; of oral contraceptive users 30-44 years of age, 20.3% (95% CI=11.0-29.5) smoked. Reported by: SE Ault, FR Dixon, MD, State Epidemiologist, Idaho Dept of Health and Welfare. ML Woelfel, MA, A Shuttleworth, DL Morse, MD, State Epidemiologist, New York State Dept of Health. Div of Reproductive Health, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Maternal smoking during pregnancy is associated with a doubling in the risk for low birth weight and with an increased risk for placenta previa, abruptio placentae, bleeding during pregnancy, spontaneous abortion, and preterm rupture of membranes (3). The 1990 Health Objectives for the Nation recommended that the proportion of pregnant women who smoke should be no more than one half the proportion of all women who smoke (4); results from these surveys indicate this objective is unlikely to be met.

Based on the reported number of live births for 1987 in Idaho and New York (5) and on the prevalence of smoking during pregnancy (data from these surveys), each year approximately 3200 infants in Idaho and 71,000 infants in New York are exposed to the potentially harmful effects of maternal smoking during pregnancy.

In both states, a substantial proportion of women who used oral contraceptives also were current smokers. For women who use oral contraceptives and smoke cigarettes, the risk for both myocardial infarction and stroke is increased, especially for older women (6,7). Therefore, smoking cessation counseling is particularly important for women taking oral contraceptives (8).

Estimates of reproductive health needs within states are often based on national or regional estimates of such needs. However, data for local areas may not exist or may differ strikingly from national data--particularly for teenagers, unmarried women, and certain racial groups. For example, among women 15-17 years of age in New York, 29.3% were current smokers (2). National surveys may not adequately sample specific subpopulations important in particular states. In the Idaho study, for example, smoking practices among Mormon women, a religious group that advocates healthy behaviors, could be compared with that of women representing other religious groups in that state. These findings underscore the potential usefulness of data from state-specific surveys to program planners and administrators who must allocate and target available resources in local areas.

During the 1980s, the prevalence of smoking in the United States declined, although the decline occurred at a slower rate for women than for men (9). Therefore, smoking prevention and cessation efforts should be focused on women. Health-care personnel who provide family planning and prenatal care services should incorporate these efforts into their counseling of reproductive-aged women.

References

1. Idaho Department of Health and Welfare. Idaho Female Health Survey, 1985: final report. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1987.

2. New York State Department of Health. New York Reproductive Health Survey, 1989: final report. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1990 (in press).

3. Office on Smoking and Health. Pregnancy and infant health. In: The health consequences of smoking for women: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1980.

4. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

5. NCHS. Advance report of final natality statistics, 1987. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989. (Monthly vital statistics report; vol 38, no. 3S).

6. Petitti DB, Wingerd J. Use of oral contraceptives, cigarette smoking, and risk of subarachnoid hemorrhage. Lancet 1978;2:234-6.

7. Shapiro S, Slone D, Rosenberg L, et al. Oral contraceptive use in relation to myocardial infarction. Lancet 1979;1:743-7.

8. Goldbaum GM, Kendrick JS, Hogelin GC, Gentry EM. The behavioral risk factor surveys group: the relative impact of smoking and oral contraceptive use on women in the United States. JAMA 1987;258:1339-42.

9. Fiore MC, Novotny TE, Pierce JP, Hatziandreu EJ, Patel KM, Davis RM. Trends in cigarette smoking in the United States. JAMA 1989;261:49-55.

• Married women comprised those currently married and those

living with a partner or boyfriend.

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